Provider Demographics
NPI:1063059731
Name:ANKRAH, JUSTINA MAME ADADEWA (LPCA)
Entity type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:MAME ADADEWA
Last Name:ANKRAH
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BUCKLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-7538
Mailing Address - Country:US
Mailing Address - Phone:704-249-4945
Mailing Address - Fax:
Practice Address - Street 1:3001 BUCKLEIGH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7538
Practice Address - Country:US
Practice Address - Phone:704-249-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional